Dealer Application - HHA Sports

Business Information

Company Name*

Phone*

Fax

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent Company (if any)

Years in business*

No. of employees*

Business License No.*

Sales Tax No.*

Type of Ownership*

Individual

Partnership

Corporation

Email*

Website

Trade Organization Memberships

Please indicate names of owners or officers

President*

Vice President*

Secretary*

Treasurer*

List other employment or locations:*

Owner's/Officer's Information 1

Name*

First Last

Title*

Home Phone*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Owner's/Officer's Information 2

Name

First Last

Title

Home Phone

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Major Supplier #1

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Account Number*

Major Supplier #2

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Account Number*

Major Supplier #3

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Account Number*

Bank Reference #1

Bank Name*

Telephone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number*

Type*

Checking Account

Loan

Bank Reference #2

Bank Name

Telephone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number

Type

Checking Account

Loan

PLEASE READ AND SIGN THE FOLLOWING STATEMENT AFTER YOU HAVE COMPLETED APPLICABLE SECTIONS

You are authorized to contact parties indicated on this application for verification. For purposes of obtaining credit, I/We certify that the information given in this application is true and accurate, and any financial information submitted correctly reflects our financial condition. I/We agree to pay all invoices within stated terms and to pay services charges on amounts paid after invoice due dates at a rate of 1.5% per month, or the maximum allowable rate, whichever is less. In event suit is instituted to collect amounts owing to you and a judgment is rendered in your favor, I/We agree to pay court costs and reasonable attorney fees. I/We have read this agreement and a copy has been made available to us or is available to us upon our requesting same from the credit department.

Applicant 1

By*

Title*

Applicant 2

Title

PERSONAL GUARANTEE – PLEASE DO NOT INCLUDE TITLE WHEN SIGNING PERSONAL GUARANTEE

For value received, including merchandise, services, or other valuable consideration, I hereby unconditionally guarantee at all times, full and prompt payment, upon demand, of any indebtedness which has been incurred under this agreement. I understand this to mean that I will personally guarantee payment of all debts and obligations under this agreement.

Applicant 1

By*

Print Name*

SS#*

Applicant 2

Print Name

SS#

Phone

This field is for validation purposes and should be left unchanged.